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46-77PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: / f) .' tiZ/jce PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j>e.bko % S C.NU.ft, /r TENANT NAME(If Commercial): <br /> "-- <br /> OWNER MAILING ADDRESS: STREET /I' 5- HD <br /> CITY 5 t/,/�'/" STATE ON. ZIP? ? ,n, <br /> OWNER PHONE: yj?f �qy R"9 �l 7QOWNER EMAIL: <br /> CONTRACTOR NAME: %/ 1 f feJ ?(Z1.CONTRACTOR ADDRESS: STREET e 0. --<-10 ? 5 j' <br /> CITY eV itT. STATE '(JL ZIPS:Oh. <br /> CONTRACTOR PHONE: g.....).5-, S-9 9/,3/ CONTRACTOR EMAIL: F� <br /> CONTRACTOR LICENSE#(REQUIRED):]/ Se/DO79 CITY OF EVERETT BUSINESS LICENSE#(REQUI!3Oa/�y <br /> PRIMARY CONTACT: 0 OWNER )2<ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 10/A5 50 rt,,, ?6 <br /> c r t---.. CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ICE.S,'Jo,.L7 61. ( Contract Price of Work:$ <br /> Proposed Use of Building: fin 01,-c....- Heat Source: ❑Gas ❑Ele tric ❑Other <br /> Building Type: ,SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair CIT.!. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> rceO c re m v t -Pm i <br /> l if)c-t I/, r _() ire t --P s'toz l.Ir s '" t�CC 6CAt'I,l <br /> a 6516- cQtL t-Y r <br /> ASSOCIATED BUILDING P MIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APP CATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn Alteration /Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> Range Hood / Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> .� sCoVIV et) CC)- —( ( 3a0—bcq <br /> Ow er/Au orized gent Signat Date (Revised 9/23/2016) <br />